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OIG: Fight fraud to increase savings


The U.S. Department of Health and Human Services' use of the Fraud Prevention System (FPS) led to $54.2 million in actual and projected savings for the Medicare fee-for-service program. However, the Office of Inspector General called for modifications to the FPS to increase savings over time, according to a report released today.

Under the Small Business Jobs Act of 2010, the OIG must certify the actual and projected savings and ROI related to the FPS. In its new report, the OIG examined unadjusted savings and cost data provided by HHS from October 2012 through September 2013.

Of the certified actual and projected savings, the report noted $10.1 million of projected improper payments stemmed from overpayment recoveries, $14.9 million of actual improper payments had been avoided via payment suspensions, and $29.2 million of projected improper payments were avoided by revoking provider billing privileges.

Based on these findings, OIG recommends changes to FPS to recoup more savings. Such modifications include creating an editing program that will reject claims through the FPS for physicians who provided services in their offices but accidentally billed them as out-of-office services.

Additionally, the OIG recommended HHS instruct contractors on how to determine whether they can attribute savings to the FPS as well as require contractors to provide documentation on how FPS contributes to an administrative action.

Despite large recoveries, certain members of Congress are not pleased with the results. "Last year, [the Centers for Medicare & Mediciad Services] estimated that improper payments were almost $50 billion ... This is a shocking amount of taxpayer money to lose every year," Rep. Tim Murphy (R-Pa.), chairman of the Energy and Commerce Oversight Subcommittee, told The Hill.

What's more, "to fight fraud effectively, insurers can use data analytics," Ted Radway, an assistant United States attorney in the fraud and public corruption section of the U.S. Attorney's Office for the District of Columbia, previously told FierceHealthPayer: Anti-Fraud in an interview. "It's also important to make early contact with law enforcement on potential fraud cases," he added. 

For more:
- here's the full report (.pdf)
- read the Hill article

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